Explainer//5 min
Gallstones on a GLP-1
Rapid weight loss has caused gallstones for as long as people have lost weight rapidly. What these drugs added was the speed, the scale, and a great many people discovering it at once.
Medications
Zepbound
Tirzepatide for obesity and sleep apnea.
18 pieces
Guide//6 min
GLP-1 dose charts, side by side
Four drugs, four different ladders, and a great deal of confusion about which rung anyone is standing on. Here is every approved escalation schedule in one place, with the reasoning behind the steps.
Explainer//6 min
GLP-1s for teenagers
Wegovy has been licensed for twelve-year-olds since 2022 and the trial data is strong. The disagreement is not really about whether the drug works, which is why it has not resolved.
Deep Dive//6 min
GLP-1s versus bariatric surgery
Surgery still produces more weight loss than any injection, and it is now being declined by people who would have accepted it three years ago. Both of those facts deserve more scrutiny than they usually get.
Guide//6 min
How long side effects last
Almost every side effect in this class follows the same shape: bad after a dose increase, better within a fortnight, mostly gone by the time you have been at a dose for two months. Almost.
Explainer//6 min
Pancreatitis on a GLP-1
Almost everyone on this drug class gets abdominal pain at some point. A very small number of them have something that needs an emergency department that evening, and the difference is learnable.
Guide//5 min
Heat, saunas and hot tubs
Heat lowers blood pressure and removes fluid from a body that is already short of both. Nothing about it is dangerous in isolation, which is precisely why people underestimate the stack.
Explainer//5 min
Sleep on a GLP-1
Most people sleep better on these drugs within a few months, for reasons that are entirely mechanical. A minority sleep considerably worse first, and almost nobody is warned about the interval.
Guide//5 min
Sulfur burps on a GLP-1
The rotten-egg burp is one of the most reliably reported side effects on tirzepatide and one of the least discussed in clinic, largely because nobody wants to be the person raising it.
Explainer//5 min
Tirzepatide, explained
Eli Lilly added a second hormone receptor to the design, largely as a bet. It produced the largest average weight loss of any approved drug, and nobody can yet fully explain why.
Guide//6 min
Do you qualify for a GLP-1?
Clinical eligibility is a short, public, unambiguous rule. Whether anyone will pay for it is a completely separate question, and conflating the two is why so many people believe they were turned down for being too healthy.
Guide//2 min
Best supplements on tirzepatide
Tirzepatide takes off more weight than any injectable before it, and the supplement question changes with the magnitude. When a fifth of your body is leaving, what you protect matters more than what you optimise.
News//3 min
The head-to-head trial, and what it settles
For three years the comparison between semaglutide and tirzepatide was made by holding two separate trials side by side, which is not a comparison. A direct trial changed that — and the result matters less to your decision than you would think.
Guide//5 min
Missing a dose of Mounjaro or Zepbound
The four-day rule, the reason it exists, and why the fix that feels most sensible — doubling up — is the one that puts people in the emergency department.
Deep Dive//5 min
Zepbound, sleep apnea, and the coverage door it opened
When Zepbound was approved for obstructive sleep apnea, it stopped being a weight-loss drug in the eyes of a large part of the American payment system. That distinction is worth thousands of dollars a year to some people.
News//4 min
Contraception, pregnancy, and the four-week rule
Tirzepatide can reduce the effectiveness of oral contraceptives — after the first dose and after every increase. It is printed on the label, it is rarely mentioned in the appointment, and it has a specific four-week window attached to it.
Guide//6 min
Winning a prior authorization appeal
Most denials are not clinical judgments. They are documentation failures, and documentation failures are the kind you can fix — if you know what the reviewer on the other end is actually reading.
Explainer//3 min
Semaglutide or tirzepatide
One is a GLP-1 agonist. The other adds GIP. The trial data favor one of them on weight — which is not the same as saying it is the right one for you.
Also in Medications
On The Jab
The
GLP‑1
Handbook
Dr. Nick Robertson
MD
The book · 14 chapters
The GLP-1 Handbook
Everything I tell my own patients before their first injection. 214 pages of what actually matters in the first year — dosing, side effects, food, muscle, cost, and the part nobody prepares you for: maintenance.
$4Less than your morning coffee.
Priced at four dollars because it should be affordable to everyone taking these drugs — not because it's worth four dollars. No upsell, no course, no supplement line.